| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
92 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
151 |
95 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
445 |
405 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
865 |
848 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
555 |
538 |
$14K |
| D1120 |
Prophylaxis - child |
364 |
356 |
$13K |
| D1110 |
Prophylaxis - adult |
214 |
210 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
37 |
$9K |
| D0330 |
Panoramic radiographic image |
130 |
125 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
142 |
134 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
223 |
208 |
$3K |
| D0274 |
Bitewings - four radiographic images |
67 |
64 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
54 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
257 |
93 |
$2K |